Avascular necrosis of the talus, especially with associated degenerative arthritis, is a challenging surgical problem. The impaired healing potential of the bone and the associated collapse and deformity of the ankle and hindfoot are obstacles to achieving a satisfactory surgical result. Several surgical techniques for ankle and hindfoot arthrodesis may be considered in the presence of avascular necrosis of the talus. These include tibiotalar arthrodesis with screw fixation, tibiotalocalcaneal arthrodesis, and tibiocalcaneal arthrodesis. The latter two techniques can be used with a variety of fixation methods, most notably with retrograde intramedullary nailing. Each technique requires both clinical and radiographic evaluation for preoperative decision-making. The indications for each as well as potential complications are discussed. A case presentation of each surgery is presented and the authors' current postoperative protocol is described.